COUNTRY PROGRAMME ACTION PLAN. between. the Government of Ukraine and UNFPA. for

Transcription

1 Government of Ukraine United Nations Population Fund COUNTRY PROGRAMME ACTION PLAN between the Government of Ukraine and UNFPA for Kyiv - Ukraine

2 Contents List of Acronyms 3 The Framework 4 Part I. Basis for Relationships 4 Part II. Situation Analysis 4 Part III. Past Cooperation and Lessons Learned 8 Part IV. Proposed Programme 9 Part V. Partnership Strategy 17 Part VI. Programme Management 17 Part VII. Monitoring and Evaluation 20 Part VIII. Commitments of UNFPA 20 Part IX. Commitments of the Government 21 Part X. Other Provisions 22 Annexes 23 Annexes Annex 1. The CPAP Results and Resources Framework Annex 2. Letter of Relationships between the Government of Ukraine and UNFPA Annex 3. Standard Basic Assistance Agreement between the United Nations Development Programme and the Government of Ukraine 2

3 List of Acronyms AIDS ANC ASRH AWP(s) BCC BTN CCA CEDAW CIS CP CPAP FACE FP GBV GCA GEL HIV ICPD IEC ILO IP(s) MCH MDGs MESYS MIPAA MOH MSP MTSP NGO PHC PLHIV PUD EMTCT RH SBAA SRH SSSU STI SW UNAIDS UNDP UNFPA UNICEF UNPF WHO YFS Acquired Immune Deficiency Syndrome Antenatal Care Adolescent Sexual and Reproductive Health Annual Work Plan(s) Behaviour Change Communication Beyond the Numbers Common Country Analysis Convention on the Elimination of all Forms of Discrimination against Women Commonwealth of Independent States Country Programme Country Programme Action Plan Funding Authorization and Certificate of Expenditures Family Planning Gender-Based Violence Government Coordinating Authority Gender Equality Law Human Immunodeficiency Virus International Conference on Population and Development Information, Education and Communication International Labour Organization Implementing Partner(s) Maternal and Children s Health Millennium Development Goals Ministry of Ukraine for Education, Science, Youth and Sports Madrid International Plan of Action on Ageing Ministry of Health Ministry of Social Policy Medium-Term Strategic Plan Non-Government Organization Primary Health Care People Living with HIV People who Use Drugs Elimination of Mother-To-Child Transmission (of HIV) Reproductive Health Standard Basic Assistance Agreement Sexual and Reproductive Health State Statistics Service of Ukraine Sexually Transmitted Infection Sex Worker Joint United Nations Programme on HIV/AIDS United Nations Development Programme United Nations Population Fund United Nations Children s Fund Ukraine United Nations Partnership Framework World Health Organization Youth-Friendly Services 3

4 The Framework The Government of Ukraine and the United Nations Population Fund (UNFPA) in mutual agreement to the content of this Country Programme Action Plan (CPAP) document and their respective roles and responsibilities in the implementation of the country programme; Furthering their cooperation for the fulfilment of the Programme of Action of the International Conference on Population and Development (1994) and achievement of the Millennium Development Goals, to which the Government of Ukraine and the United Nations Population Fund are committed; Building upon the experience gained and progress made during the implementation of the previous UNFPA country programme ( ), and based on the Ukraine - United Nations Partnership Framework ( ); Entering into a new period of cooperation ( ); Declaring that these responsibilities will be fulfilled in a spirit of close cooperation have agreed as follows: Part I. Basis of Relationships The Standard Basic Assistance Agreement (SBAA) between the Government of Ukraine and the United Nations Development Programme (UNDP), dated 18 June 1993 and the exchange of letters between the Government represented by the Ministry of Foreign Affairs of Ukraine and United Nations Population Fund, dated 22 March 2006, constitute the legal basis for the relationship between the Government of Ukraine and United Nations Population Fund. Part II. Situation Analysis 2.1. According to the 2011 UNDP Human Development Report, Ukraine ranks 76 out of 187 countries, with a human development index of 0.729, one lower than average for Eastern Europe. Ukraine is a lower-middleincome country with a per capita gross national income of $6,698 in After gross domestic product (GDP) falling by 14.8 per cent in 2009, the economic growth gradually resumes: in 2010 the actual GDP growth was at 4.2 per cent, the projected 2011 growth is at 5 per cent. Despite the average annual GDP growth rate of 7.5 per cent during and successes in combating absolute poverty, progress towards achieving the MDGs remains uneven. Over 24 per cent of the population lived in poverty according to the national poverty criterion (2010). Population groups most vulnerable to poverty include rural inhabitants, families with children and older persons In 2010, the Government embarked on an ambitious social and administrative reform programme. Although overall spending on social benefits is high, (accounting for about 25 per cent of the gross domestic product in 2010), only about one quarter of social transfers reach the poor. Increased financing for health care and education has failed to translate into increased access to services or to an improvement in service quality, suggesting an urgent need for reforms to improve the management of these sectors. Population 2.3. With regard to population and development the overall situation is acknowledged by the Government and national experts as a demographic crisis. The current situation is the accumulated impact of a wide range of social, economic, political and ecological factors due to social and economic transition processes over a number of decades. In summary, the following characterise Ukraine s demographic challenges: 1 IMF World Economic Outlook 2011 ( 4

5 Below replacement birth rate High mortality (especially among men in the working age) Poor health (including reproductive and child health) Low longevity with gender disparities in life expectancy at birth Population ageing Significant external and internal labour migration High relative poverty and income stratification Widening gap in development and living standards between rural and urban areas Increasing prevalence of HIV which may be impacting the demographic profile 2.4. The population of Ukraine decreased from million in 1992 to million as of 1 September The country lost 6.57 million people (12.6 per cent), in 18 years. Roughly 80 per cent of this dramatic loss results from depopulation, while 20 per cent is attributed to migration losses. While the average Eastern European population decline rate has been 0.4 per cent for , for Ukraine it was 0.6 per cent 3. The total fertility rate in Ukraine was in 2010, and has demonstrated an upward trend since year This notwithstanding, should the current fertility, life expectancy and migration trends persist, by 2050 the population of Ukraine might shrink down to 39.2 million people (according to the medium variant projection), which means a possible loss of nearly 6.5 million people or about 14 per cent of the current population The poor health status of the population, largely due to behavioural and environmental factors, and limited access to high-quality health care, especially in rural areas, constitute a key development challenge. Socio-economic conditions in rural areas are very poor (labour conditions, housing, nutrition, access to health and social infrastructure, communications, transportation to name a few). In only five out of 27 of the country s administrative regions natural population growth has been observed in Average life expectancy at birth was years for men and years for women in the period demonstrating a notable increase in the recent 3 years. The mortality rate for men aged years is three times higher than the mortality rate for women. Should the existing morbidity and mortality patterns continue, about one third of the people in Ukraine will die before the age of 65. About 55 per cent of such early deaths are preventable Seventy one per cent of Ukrainian families have only one child (compared with 61 per cent in 2000), and many couples opt not to have children for economic reasons. The most prevalent family in Ukraine consists of two persons (35.9 per cent), while families of three have a 30 per cent share Ukraine has a high percentage of older people: 15.7 per cent of the population is aged 65 or older. Two thirds of this elderly population is female. The share of older persons in Ukraine has remained steady for a number of years and is comparable with the European averages. Demographic ageing is occurring more rapidly in the rural areas than in urban settlements due to labour migration of young people. There are also regional differences: the proportion of people over 60 ranges from 15.4 per cent in Zakarpatska region to 26.7 per cent in Chernigivska. One third of rural-residing women are above the age of 60. According to population projections, by 2050 every third resident of Ukraine will be over Population data here and below by the State Statistics Service of Ukraine unless otherwise stated. 3 The State of World Population 2010 UNFPA. 4 Comprehensive Population Projection for Ukraine until 2050 State Statistics Committee, Institute of Demography and Social Studies, UNFPA, 2006 (updated 2011). 5 Mortality in the Working Age Institute for Demography and Social Studies of the National Academy of Sciences of Ukraine, Family and Family Relationships in Ukraine Institute for Demography and Social Studies of the National Academy of Sciences of Ukraine, Ukrainian Centre for Social Reforms, UNFPA,

6 2.9. According to established estimates, external labour migration over the last few years constituted up to 2.0 to 2.7 million people (mostly to Russia). About ¾ of Ukrainian labour migrants work abroad illegally 7. The remittances from labour migrants wired to Ukraine steadily increase and valued at $5.1 billion in In a condition of shrinking labour force, the Government is considering migration as an important socioeconomic phenomenon and is exploring its development implications, which is evidenced by the recent adoption of the concept of a national migration policy. Ukraine is also a country of significant migration transit, which carries with it challenges related to the rights of transiting migrants Economic hardships, deteriorated social and health care systems are the most important drivers of the severe demographic situation in Ukraine. In 2006 the Government adopted a strategy of demographic development of Ukraine for the period until While the strategy addresses the main demographic issues and concerns, its implementation has been a challenge. Many of the national socio-demographic policies and programmes tend to be primarily declarative without the accompanying mechanisms, processes, financing and political will necessary for actual implementation. Reproductive Health In recent years, with the exception of HIV infection and rise of infertility, the situation with regard to reproductive health has improved. Coverage of pregnant women with antenatal care by health professionals stands at 98.5 per cent, and skilled attendance at birth is provided in over 99 per cent cases 9. The prevalence of labour and delivery complications was 33.3 per cent in 2010, reduced from its peak of 69 per cent in This notwithstanding in terms of access to quality reproductive health including maternal health information and services, there is room for improvement. The availability and accessibility of reproductive health and family planning services, including information services and commodities, are still insufficient. Access to services is not universal and with a few exceptions limited to major cities. The right to health of rural populations remains compromised by such access limitations. The people s demand for better reproductive health needs to be further promoted and advocated for The maternal mortality ratio in Ukraine was 23.5 deaths per 100,000 live births in 2010, an increase from 15.2 deaths per 100,000 live births in Ukraine s maternal mortality exceeds the average level of the EU countries. Inadequate quality of maternal health care services accounts for about one fifth of preventable maternal deaths. The main causes of maternal deaths are non-obstetric causes, haemorrhage and obstetric embolism. Cases of maternal deaths are usually investigated in a prosecuting manner without examination of the root causes and factors other than clinical. The infant mortality rate decreased from 9.8 deaths per 1,000 live births in 2006 to 9.1 deaths per 1,000 live births in Achievements in the area of family planning contributed to a decrease in the abortion rate, from 34.1 abortions per 1,000 women of reproductive age in 2000 to 15.1 in Nevertheless, Ukraine s abortion rates remain more than twice as high as those of the EU countries. The fact that many women still rely on abortion as a family planning method is likely to be indicative of unmet need and/or ineffective or inappropriate use of modern contraception. The MOH reports that while the number of abortions among years old youth is decreasing, it remains high in some regions such as Mykolaivska and Kirovogradska compared to western regions of Ukraine. There is also a problem associated with the lack of safe abortions practices offered by health care providers and/or access to such services especially in rural areas. 7 Migration Processes in Ukraine Institute for Demography and Social Studies of the National Academy of Sciences of Ukraine, IOM, Migration and Remittances Factbook. World Bank, Ukraine Demographic and Health Survey 2007 Ukrainian Centre for Social Reforms, State Statistics Committee of Ukraine, Ministry of Health of Ukraine, Macro Intl. Inc., Millennium Development Goals: Ukraine Progress Monitoring Summary. Ministry of Economic Development and Trade of Ukraine, Ditto. 6

7 2.15. A number of legislative and strategic documents approved by the Government of Ukraine accords priority to reproductive health. The national programme Reproductive Health of the Nation ( ) defines its main objectives as preserving the reproductive health of the population and shaping reproductive health in children and youth. This programme envisages budgetary support for procurement of RH commodities and designates four vulnerable groups eligible for free contraception namely women with extra-genital pathology, women living with HIV, low income women and youth (18-20 years of age only). Limited state funding however goes to support the procurement of free contraceptives for women living with HIV and those with extra-genital pathology, while local budgets are expected to allocate their resources to procure commodities for youth and socially disadvantaged women. Programme implementation therefore is often challenged due to lack of consistent funding and institutional support. In addition the programme does not have funds to update training of FP providers, promote modern FP methods, and implement public education activities or support of institutional capacity building. Thus the Government continues to look to external donor support for such activities The contraceptive prevalence rate for hormonal contraception and IUDs, according to official health statistics, was 31.9 per cent in Overall contraceptive prevalence has been at a plateau for the last decade or so. The use of any contraceptive method has changed little in recent years (68 per cent in 1999 to 67 per cent in 2008) 13. While the use of modern contraceptive methods 14 increased 34 per cent over the same period, from 38 per cent in 1999 to 51 per cent in , the use of hormonal contraception is still twelve times lower in Ukraine than in the European Union 16. The sources of modern contraception in Ukraine are pharmacies (49.3 per cent); public sector mostly women s consultation centres and hospitals/maternity homes 27.8 per cent, other primarily friends/relatives/neighbours 20.3 per cent, and private sector providers 1.6 per cent 17. In 2007, only 4 per cent of modern method users received their contraceptive method free of charge (those eligible for free contraceptives according to national regulations) In terms of coverage of family planning care, while family planning is part of the official job description of general practitioners and family doctors, a recent survey found that in Kiev only 38 per cent of them provide family planning. Only 30 per cent of district therapists (internists) provide family planning 19. An increase in the number of family medicine doctors, as well as provision of complete family planning training for them (currently the training is inadequate), could improve the extent and quality of family planning in Ukraine dramatically The incidence of sexually transmitted infections (STIs) has held steady for the last five years. The incidence of syphilis is more than 7.5 times higher than the European Union average, and the incidence of gonorrhoea is more than 4.5 times as high. According to estimates, cases of sexually transmitted infections are under-reported in Ukraine. Insufficient and inaccurate reporting of STI, especially of gonorrhoea, is very common for patients treated privately. Due to the availability of over-the-counter treatments, selfmedication/treatment is a growing phenomenon Ukraine has the highest HIV adult prevalence rate (1.3 per cent) among countries of Europe and Central Asia. Annual HIV diagnoses have more than doubled since The HIV epidemic, concentrated among people who use injecting drugs and sex workers (including their sexual partners), mostly affects young people. Sexual transmission is increasing. The mother-to-child HIV transmission rate is 6.2 per cent. Between 2005 and 2009 a large and growing epidemic grew among female sex workers. In 2007 the proportion of HIV cases due to sexual transmission rose above the proportion associated with use of injecting drugs, and sexual transmission continues to increase as HIV bridges out from people using drugs to 12 Status of Women s Health in Ukraine in Ministry of Health of Ukraine, WHO, Modern contraceptives are defined here as female and male sterilization, intrauterine devices, hormonal methods, condoms, and vaginal barrier methods. 15 Ukraine Demographic and Health Survey 2007 Ukrainian Centre for Social Reforms, State Statistics Committee of Ukraine, Ministry of Health of Ukraine, Macro Intl. Inc., Zhuravliov et al., Ukrainian Centre for Social Reforms et al., Ditto. 19 Menon,

8 their sexual partners (predominantly female), with a concomitant increase in the proportion of women who are infected in Ukraine Only around one half of the Ukrainian young people aged years have correct comprehensive knowledge of HIV/AIDS: 44.8 per cent women and 42.8 per cent men. Knowledge and awareness however does not appear to be increasing among the population and has remained at the same levels for several years now. Furthermore, knowledge on HIV infection prevention, reproductive health, substance abuse, including alcohol and tobacco 20 does not appear to be transforming into safe behavioural practices. Gender Equality In the last two decades, Ukraine has achieved considerable progress for the promotion of gender equality by establishing the core elements of an appropriate legal and institutional framework. Ukraine has ratified the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) and its Optional Protocol, and has endorsed the Beijing Platform of Action adopted at the Fourth World Conference on Women (1995) In spite of this progress, due to ineffective implementation of the various legal instruments and the persistence of stereotypical notions regarding the status and roles of men and women, gender equality is far from being a reality in Ukraine. The gender inequality index value of Ukraine was in 2010, ranking it 57 of 187 countries 21. The number of women in the Ukrainian Parliament stands at only 8 per cent. Few women occupy decisions making positions in public and private sectors. On average women s salaries are 78 per cent to that of men While reliable statistics are hard to come by, a sociological research carried out by the EU-UNDP Equal Opportunities and Women s Rights Programme in late 2009-early 2010, estimates that nearly half (44 per cent) of the Ukrainian population suffered from domestic violence in their lives, and 30 per cent were subjected to violence during their childhood. Gender-based discrimination and violence, including domestic violence, are of growing concern and need to be addressed at both policy and community levels The on-going public administration reform poses concrete challenges with regards to the strengthening of a national mechanism on gender equality. Thus, for Ukraine, in order to be able to meet the MDG on gender equality, there is an immediate need to further improve the legal framework on gender equality, to enable the equal participation of men and women in all socio-economic spheres. Part III. Past Cooperation and Lessons Learned 3.1. The first country programme for Ukraine 2006 to 2011 had a budget of $3.2 million funded by regular resources. The country office mobilized an additional $7.7 million from other resources, a significant amount in a middle-income country. Government co-funding of the country programme accounted for $1.7 million The first UNFPA country programme addressed reproductive health, population and development, and gender equality. Advocacy and policy dialogue, strengthening methodologies and evidence base, and developing partnerships were main strategies engaged by the programme In the area of reproductive health, the first country programme supported: (a) the nationwide integration of reproductive health services, resulting in improved access to services; (b) improved availability of reproductive health services for women and girls living with HIV; (c) the development of institutional systems to prevent HIV infection in the uniformed services; (d) the promotion of healthy lifestyles and safe behaviour among young people and vulnerable populations through information, education and behaviour change communication; and (e) the development of social services for people who use injecting drugs. 20 Safestyling: Living in a Safe Style UNFPA, Human Development Report UNDP. 8

9 3.4. Under the population and development programme component, UNFPA supported: (a) the development of the national strategy on demographic development; (b) comprehensive demographic research; (c) the creation of an evidence base on the demographic factors of social changes; (d) the preparation for the 2012 national population census; and (e) national implementation of the International Plan of Action on Ageing at the policy and service-delivery levels In the area of gender equality, the country programme: (a) strengthened the capacity of civil society to prevent gender-based discrimination and violence through training and networking of non-governmental organizations (NGOs) and supporting their small projects; and (b) fostered the involvement of men in promoting gender equality and reproductive health and rights Lessons learned during the first programme cycle, as identified by the end-line programme evaluation, point to the need to: (a) improve positioning the UNFPA agenda with the Government at national and regional levels; (b) strengthen UNFPA interventions in the area of maternal health and family planning; (c) ensure synergistic programmatic and policy support to utilize available resources, with a focus on defined rural areas and populations that are most at risk; and (d) strengthen the strategic linkages between programme components and improve coordination with other United Nations organizations and development partners. Part IV. Proposed Programme UNFPA Country Programme in the National Development Context 4.1. The second UNFPA Country Programme (CP) for Ukraine contributes to the achievement of the Ukraine s Millennium Development Goals (MDGs) for reducing poverty, promoting gender equality, improving maternal health and slowing down the spread of HIV and other STIs. The programme will support the implementation of the following on-going national policies and programmes: National Programme Reproductive Health of the Nation for period until 2015 (approved by the resolution of the Cabinet of Ministers of Ukraine of 27 December 2006 No. 1849); National Programme on HIV Infection Prevention, Treatment, Care and Support of People Living with HIV and AIDS ( ); Strategy of Demographic Development for period until 2015 (approved by the resolution of the Cabinet of Ministers of Ukraine of 24 June 2006 No. 879) The CP is aligned with the Ukraine-UN Partnership Framework (UNPF) for and fits within the revised global outcomes of UNFPA medium-term Strategic Plan (MTSP) for as presented in the table below. CP Output MTSP Outcome UNPF Outcome National Development Priority Output 1: Strengthened national capacity to develop, implement and monitor reproductive health and family planning policies and standards of care Outcome 1: Population dynamics and its interlinkages with the needs of young people (including adolescents), SRH (including family planning), gender equality and poverty reduction addressed in national and sectoral development plans and strategies Social Development Outcome 1: Improved access to and utilization of highquality health, education and social services Goal 5A: Improve maternal health by halving the maternal mortality ratio Goal 6A: Reduce and slow down the spread of HIV/AIDS by decreasing the HIV prevalence rates by 13 per cent 9

10 CP Output MTSP Outcome UNPF Outcome National Development Priority Output 2: Improved quality of maternal health and family planning services in underserved rural areas Output 3: Healthseeking behaviour promoted among young people and key populations in selected regions to improve sexual and reproductive health Output 4: Strengthened national capacity to address emerging population issues Output 5: Women s empowerment and gender equality promoted through gender-sensitive policies and prevention of genderbased violence Outcome 3: Increased access to and utilization of quality maternal health and family planning services for individuals and couples according to reproductive intentions Outcome 3: Increased access to and utilization of quality maternal health and family planning services for individuals and couples according to reproductive intentions Outcome 1: Population dynamics and its interlinkages with the needs of young people (including adolescents), SRH (including family planning), gender equality and poverty reduction addressed in national and sectoral development plans and strategies Outcome 1: Population dynamics and its interlinkages with the needs of young people (including adolescents), SRH (including family planning), gender equality and poverty reduction addressed in national and sectoral development plans and strategies Social Development Outcome 1: Improved access to and utilization of highquality health, education and social services Social Development Outcome 3: More people adopt healthy and safe behaviour Social Development Outcome 2: People are aware of their rights and are able to exercise them, thereby reducing their vulnerability Social Development Outcome 2: People are aware of their rights and are able to exercise them, thereby reducing their vulnerability Goal 5A: Improve maternal health by halving the maternal mortality ratio Goal 6A: Reduce and slow down the spread of HIV/AIDS by decreasing the HIV prevalence rates by 13 per cent Goal 5A: Improve maternal health by halving the maternal mortality ratio Goal 6A: Reduce and slow down the spread of HIV/AIDS by decreasing the HIV prevalence rates by 13 per cent Goal 1B: Decrease the percentage of the population that is poor to 23.9 per cent by reducing the number of children and employed people who are poor Goal 1C: By the year 2015, decrease by 10 times the number of people whose daily consumption is below the actual subsistence minimum Goal 3A: Ensure gender representation at the level of 30 to 70 per cent in representative bodies and high-level executive authorities Goal 3B: halve the gap in incomes between women and men 10

11 CP Output MTSP Outcome UNPF Outcome National Development Priority Output 6: Availability of disaggregated population data for national and sectoral development policymaking, programming and public use Outcome 7: Improved data availability and analysis resulting in evidence-based decisionmaking and policy formulation around population dynamics, SRH (including family planning), and gender equality Social Development Outcome 4: Social development policy making at national and sub-national levels is evidence-based Goal 1B: Decrease the percentage of the population that is poor to 23.9 per cent by reducing the number of children and employed people who are poor Goal 1C: By the year 2015, decrease by 10 times the number of people whose daily consumption is below the actual subsistence minimum 4.3. The programme results from wide consultations with concerned ministries and state institutions of Ukraine, non-governmental organizations, as well as UN agencies, donor countries and international organizations providing development assistance to Ukraine. It draws on the experience and lessons learned from the previous country programme and recommendations of an end of programme evaluation carried out in This approach has ensured that all key players, under the leadership of the Government, have a common vision of the country's development perspectives in the areas related to UNFPA s mandate, and that the activities envisaged by the CP will complement efforts of other agencies UNFPA will play a distinctive role in engaging into technical cooperation based on the following comparative advantages: Internationally acknowledged mandate and mission to address the population and development challenges; Availability of an excellent range of technical resources and expertise, including Ukraine s national experts in family planning, reproductive and maternal health, HIV/STIs, health education and promotion, demography, population and development, social gerontology, gender sciences; Fifteen years experience of design and successful delivery of projects and programmes on family planning and reproductive health, HIV/STI prevention, safe behaviour promotion, population research, improving lives of older people, and combating gender-based discrimination and violence; Well-established contacts and politically neutral partner relations with governmental and nongovernmental stakeholders (including faith-based organizations) to advance the International Conference on Population and Development (ICPD) agenda; Good integration into the UN country activities as a strong supporter of the Delivering as One principle UNFPA will reposition itself in Ukraine as a development leader in the area of reproductive health and rights, maternal health, family planning, and prevention of HIV and other STIs. The CP will focus on active Government involvement, ownership and leadership of the programme, will prioritize rural and most-at-risk populations, and will deliver assistance to selected geographical regions, particularly to the underserved rural areas, to maximize impact The CP is expected to deliver six specific outputs over the five-year cycle. Needs of young people and key populations, human rights and gender equality, and fostering effective partnerships will be addressed throughout the programme as crosscutting issues. The CP will promote and facilitate exchange of knowledge and experience on issues of concern between the countries of the Eastern Europe and Central Asia wherever possible. 11

12 Output 1: Strengthened national capacity to develop, implement and monitor reproductive health and family planning policies and standards of care 4.7. In line with the goals and objectives set forth by the national programme Reproductive Health of the Nation for period until 2015 (approved by the resolution of the Cabinet of Ministers of Ukraine of 27 December 2006 No. 1849) and the health sector reforms initiated by the President of Ukraine in 2010 (Programme of Economic Reforms for Wealthy Society, Competitive Economy, Effective State ), UNFPA will support the Government and the Ministry of Health in the structural reorganization of the health care system to strengthen primary health care services and make quality, accessible and affordable health care services available, particularly in the underserved areas. UNFPA will support the Government in these reforms, through provision of necessary technical assistance and capacity development activities to ensure increased access and utilization of high quality reproductive health, maternal health, family planning, and HIV/STI prevention information and services The programme will support the Ministry of Health to strengthen coordination mechanisms for improved planning, monitoring and evaluation of reproductive health programmes including reproductive health commodity security (RHCS) UNFPA will initiate and support an inter-agency Reproductive Health Partner Group to ensure a wellcoordinated and coherent approach to promoting reproductive rights and planning and delivering reproductive health programmes in the country. This coordination group will serve as a coordination mechanism and platform for advocacy, policy dialogue, partnership development, information sharing, design and implementation of joint activities, and resource mobilisation. It will also ensure monitoring of the progress made in improving the reproductive health situation in Ukraine with reference to objectives set forth in national policies and programmes. Among key issue to be addressed through the above coordination mechanisms will be improvement of the national system of sexual and reproductive health statistics, recommendations for a well-defined package of SRH and FP services for the various tiers of the health system and strengthening RHCS and comprehensive condom programming (CCP). The group will also serve as platform for the coordination and partnership in support of the formulation of a new national reproductive health programme beyond In order to ensure high quality sexual and reproductive health and family planning services UNFPA will support the review and revision of existing national standards and protocols of care, development of new protocols ensure these are evidence based and in line with international standards. UNFPA will support the MOH in defining a comprehensive package of SRH and FP services for the various tiers of the health system. In addition, UNFPA will work to develop national capacities to regularly review and update the RH standards and protocols of care to ensure their compliance with international standards UNFPA will work with the MOH, the Parliament of Ukraine and other relevant stakeholders including the academia, NGOs, civil society sectors and development partners to strengthen the coordination and regulatory framework for sexual and reproductive health and family planning. Output 2: Improved quality of maternal health and family planning services in underserved rural areas Although significant progress has been achieved in Ukraine to reduce the maternal mortality ratio, there are still incidents of maternal deaths that could have been prevented. To address this, punitive measures and investigations need to be gradually replaced with audit methodologies that enable health care practitioners and planners to identify and address missed opportunities and/or remedial clinical, health system or community based factors to avoid such deaths. UNFPA in collaboration with WHO will support the MOH to adapt and implement two complementary Beyond the Numbers (BTN) maternal mortality and morbidity case reviews methodologies, namely Confidential Enquiries into Maternal Deaths systematic multi-disciplinary anonymous investigation of all maternal deaths occurring at national level to identify the numbers, causes and avoidable or remediable factors associated with them, and Near-Miss Case Review identification and assessment of cases in which pregnant women survive severe obstetric complications. International technical expertise and capacity development of regional and national level health care 12

13 managers and practitioners will be provided to support full-scale implementation of the BTN methodology, including development and adoption of the necessary legal framework. The operationalization of the BTN approach will facilitate evidence-based recommendations for improving maternal care in the country, improve existing clinical guidelines (protocols), eliminate harmful practices, and provide solid evidence for comprehensive reform of maternal and perinatal health care service delivery, including regionalization of care In line with its mandate and in support of the national reproductive health programme s aim of making high quality reproductive health, family planning and youth friendly services available in at least 90% of outpatient polyclinics, pediatric healthcare facilities and underserved rural areas, UNFPA will support the MOH to strengthen primary health care (PHC) and roll out a network of general practitioners and family doctors with updated skills and training in sexual and reproductive health services. UNFPA will support the MOH and work with the regional (oblast) health departments of 3-4 target regions to develop effective models of high quality SRH and family planning services. UNFPA in collaboration with WHO, USAID and other development partners will support the in-service trainings of PHC practitioners in the selected regions, including nurses and midwifes. A training curriculum will be developed and rolled out on youth friendly approaches, including access to family planning, condoms, HIV/STI testing, counselling and treatment in non-judgmental and confidential settings. An in-service training programme for youth-friendly services (YFS) will be rolled out. UNFPA will also support the development of guidelines for PHC practitioners in rural areas on youth-friendly family planning counselling. Review and update of pre-service curriculum for nurses and midwives on family planning using youth friendly approaches for FP counselling will be undertaken, which will ensure long-term sustainability and institutionalization at the national level. Strengthening demand for family planning and promotion of safe sexual behaviour among youth and key populations will be undertaken through complementary efforts in the education sector and at the community level The national AIDS programme for is committed to elimination of mother-to-child transmission (EMTCT) of HIV. UNFPA jointly with UNICEF and UNAIDS will provide technical expertise to conduct an assessment of the quality of reproductive health and family planning counselling at EMTCT settings. Based on findings of the assessment UNFPA in selected regions will support capacity development of EMTCT service providers for providing SRH/FP counselling. A key focus will be on ensuring rightsbased delivery of SRH care including for PLHIV and key populations access to prevention services, FP and SRH choices including the right to safe delivery and child care. Output 3: Health-seeking behaviour promoted among young people and key populations in selected regions to improve sexual and reproductive health UNFPA will work with Ministry of Education, Science, Youth and Sports, MOH and other relevant stakeholders to strengthen sexual and reproductive health education, including HIV awareness education in secondary and vocational training schools. The programme will support the development and implementation of effective tools and approaches including interactive classroom-based trainings and extracurricular activities. Existing effective modules of peer-to-peer education, as well as institutional and human resource capacities, will be updated/improved with the most recent recommendations and best practices of UNFPA, UNESCO, WHO and other UN agencies on sexual and reproductive health education. These activities will contribute to a new Grow Healthy course for adolescents of years of age in which RH, FP and HIV/STI education are integrated into a broader healthy lifestyles concept. School-based activities will be also complemented through community-based health promotion initiatives and outreach through local and social media. The programme will also support the design and implementation of information, education and communication (IEC) activities on health issues that promote healthy lifestyle, family planning, and reproductive health, safe motherhood and prevention of cancers for the general population In accordance with the UNAIDS division of labour and reduction of sexual transmission of HIV, UNFPA will spearhead interventions to reduce sexual transmission by reaching out to most at risk groups such as youth and sex workers. UNFPA will support the empowerment of these groups through advocacy (including advocacy for legal reform), IEC/BCC for condom use among key populations, and integrated HIV 13

14 and RH services. Interventions will include the development of targeted informational kits and short public announcements on HIV prevention on the road, empowering sex workers through awareness and knowledge and the integration of HIV and RH services. UNFPA will also strengthen the capacity of the National Truck Drivers Training and Counselling Centre through the development of a course on HIV prevention to be included into the training curriculum of the Centre UNFPA will continue to strengthen the linkages and integration of HIV and SRH to develop/expand user friendly and comprehensive SRH/HIV/STI services. This will be achieved through further developing the capacities of health and social services (AIDS centres, STI clinics, youth-friendly clinics, centres of social services for youth, harm reduction services, FP/ANC/MCH/ASRH and PHC) with a focus on improving SRH-HIV links at policy, system and integrated service delivery levels (particularly in the context of the health system reform). Effective mechanisms, approaches and techniques in provision of user-friendly, comprehensive, one-stop-shop SRH/HIV/STI services tailored specifically to address the needs of sex workers and people using drugs will be addressed. Output 4: Strengthened national capacity to address emerging population issues As the current national Strategy of Demographic Development expires in 2015, UNFPA will deliver technical assistance to the Government for the elaboration of a new mid-term population development strategy for Ukraine to start in 2016, to be grounded on the analysis of population dynamics in UNFPA will continue advocacy and political dialogue with the Government to ensure the population and development linkages are considered and integrated in the national and sectoral development policies, programmes and plans. The CP will also provide assistance to the Government in preparing a national analytical report on the implementation on the ICPD Programme of Action dedicated to the 20 anniversary of ICPD in Advocacy activities will include individual negotiations with key stakeholders, thematic press conferences, commemorations of the World Population Day and other UN Days, presentations of the State of the World Population Reports, ensuring the participation of Ukraine s representative in the international population and development events, as well as leveraging donor resources where possible to support the implementation of the CP In line with UNFPA s focus on addressing population dynamics, the issue of population aging is one of the key emerging issues that need to be addressed in the country. UNFPA will further assist the Government in the development and implementation of the national policy on population ageing in accordance with the Madrid International Plan of Action on Ageing (MIPAA) and United Nations Principles for Older Persons. A national action plan on ageing, developed by the Government with technical assistance from UNFPA, will reflect the national priorities to be addressed in the mid-term perspective with regard to population aging, and will make an effort integrating the on-going administrative reforms into national measures on adapting the society to changing population age structures and improving the quality of life in older age. UNFPA will provide technical and financial resources to support the policy level activities, e.g. policy analysis, review and improvement of respective legislation, implementation monitoring and evaluation, international cooperation, in order to facilitate the implementation of the national action plan on ageing. Along with that, the CP will support capacity development of national policy and decision makers in population ageing related policies and programmes exposing them to the world s best experiences and practices. UNFPA will also facilitate the preparation of the official progress report by the Government on the implementation of the MIPAA due in The ageing related activities in Ukraine will be aligned with the UNFPA regional programme The CP will support the national capacity building, especially in the regions and rural areas of Ukraine, to implement the national action plan on ageing through local programmes and projects targeted at improving the quality of life in older age and enabling older persons to lead active and healthy lives. This support will be channelled not only through the governmental organizations providing services to older persons, but also through NGOs and community-based organizations of older persons (e.g. local level veterans organizations). These programmes will promote the UN Principles for Older Persons and help older people enjoy their rights as plenipotentiary and respected members of the society. 14

15 Output 5: Women s empowerment and gender equality promoted through gender-sensitive policies and prevention of gender-based violence Gender equality and empowerment of women have been accorded priority under the recently launched reforms in Ukraine. The responsibility for gender has now been transferred to the Ministry of Social Policy (MSP), which bodes well for the mainstreaming of gender equality in all national policies, plans and programmes A key thrust of the UNFPA CP will be to address structural and economic barriers to equality and empowerment through the promotion and enforcement of gender equality in laws, practices, policies and value systems to improve women s capacities, opportunities and decision making power. As mentioned earlier, in spite of some notable progress gender equality is still far from being a reality in Ukraine. UNFPA supported programme activities will range from sensitizing policy makers, parliamentarians, media on gender issues, the development and implementation and enforcement of laws and legislation that protect the rights of women and girls, to community level interventions that aim to eliminate gender-based violence (GBV). The programme is closely aligned with the national gender policy and national gender action plan UNFPA will work at the policy/legislative and community levels. At the policy level UNFPA will support the MSP to coordinate and mainstream gender equality in key national plans, policies and programmes. Institutional strengthening of the MSP in terms of re-establishment of the national machinery under the Ministry and developing capacity for gender mainstreaming will be an undertaking of the programme. Activities will include among others training and capacity development on how to mainstream a gender perspective and analyses into relevant policies, programmes and activities. Major national and sectoral policies, programmes and legislation will be reviewed to ensure gender perspectives are integrated The existence of gender inequality in the Ukrainian labour market is widely documented 22. In collaboration with the ILO support will be provided to the MSP to reconcile women s work and career aspirations with their family responsibilities. UNFPA will provide technical expertise for ensuring gender equality is adequately reflected in major pieces of legislation such as the Labour Law and also advocate for coherence between various pieces of legislation on matters of gender equality and non-discrimination UNFPA will provide support to strengthen the evidence base on gender-based discrimination in both domestic and public spheres. Towards this end, UNFPA will support selective research to strengthen advocacy efforts for policy measures as such as the feminine face of ageing in Ukraine, the gender wage gap to mention a few areas In the area of gender-based violence (GBV) UNFPA support will be provided to the updating/strengthening of existing legislation and development of new legislation (as appropriate). The enforcement and operationalization of legislation will also be a priority. At the community level in selected regions (oblasts) UNFPA will continue to raise awareness on GBV and on human rights. Strategies such as male involvement and socialization of boys on gender equality issues through complementary interventions with the Ministry of Education will also be undertaken. There is a continued need for awareness raising on discrimination and measures to ensure gender equality and non-discrimination. This concerns in particular a much needed public debate on the possible unintended consequences of protective measures and the need to strike a balance between protection and employability In addition, UNFPA will support activities aimed at addressing entrenched ideas about gender roles such as training of media practitioners on gender sensitive portrayal of women in advertising and mass media; the training of journalists will be undertaken with the aim of establishing standards for media reporting and to increase the understanding of journalists on issues related to HIV/AIDS, gender and reproductive health. 22 Ukraine National MDG Report 2010; Ukraine Human Development Report